Testing the Addition of 131I-MIBG or Crizotinib to Intensive Therapy in People With High-risk Neuroblastoma (NBL)

Status: Recruiting
DFCI Protocol ID: 18-718

This partially randomized phase III trial studies iobenguane I-131 or crizotinib and standard therapy in treating younger patients with newly-diagnosed high-risk neuroblastoma or ganglioneuroblastoma. Radioactive drugs, such as iobenguane I-131, may carry radiation directly to tumor cells and not harm normal cells. Crizotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving iobenguane I-131 or crizotinib and standard therapy may work better in treating younger patients with neuroblastoma or ganglioneuroblastoma.

Conducting Institutions:

Brigham and Women's Hospital, Dana-Farber Cancer Institute, Children's Hospital Boston

Overall PI:

Suzanne Shusterman, MD, Dana-Farber Cancer Institute

Site-responsible Investigators:


Dana-Farber Cancer Institute: Childrens Hospital Pediatric Clinical Translation Investigation Program CTIP, ctip@partners.org

Eligibility Criteria

Inclusion Criteria:

  -  Patients must be enrolled on ANBL00B1 or APEC14B1 prior to enrollment on ANBL1531

  -  Patients must have a diagnosis of neuroblastoma or ganglioneuroblastoma (nodular)
     verified by tumor pathology analysis or demonstration of clumps of tumor cells in bone
     marrow with elevated urinary catecholamine metabolites; the following disease groups
     are eligible:

       -  Patients with International Neuroblastoma Risk Group (INRG) stage M disease are
  eligible if found to have either of the following features:

    -  MYCN amplification (> 4-fold increase in MYCN signals as compared to
       reference signals), regardless of age or additional biologic features; OR

    -  Age > 547 days regardless of biologic features

       -  Patients with INRG stage MS disease with MYCN amplification

       -  Patients with INRG stage L2 disease with MYCN amplification

       -  Patients > 547 days of age initially diagnosed with INRG stage L1, L2 or MS
  disease who progressed to Stage M without prior chemotherapy may enroll within 4
  weeks of progression to Stage M

       -  Patients > 365 days of age initially diagnosed with MYCN amplified INRG stage L1
  disease who progress to Stage M without systemic therapy may enroll within 4
  weeks of progression to stage M

  -  Patients initially recognized to have high-risk disease must have had no prior
     systemic therapy (other than topotecan/cyclophosphamide initiated on an emergent
     basis); patients treated with a single cycle of chemotherapy per a low or intermediate
     risk neuroblastoma regimen (e.g., as per ANBL0531, ANBL1232 or similar) for what
     initially appeared to be non-high risk disease but subsequently found to meet the
     criteria will also be eligible; patients who receive localized emergency radiation to
     sites of life-threatening or function-threatening disease prior to or immediately
     after establishment of the definitive diagnosis will be eligible

  -  Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
     mL/min/1.73 m^2 or a serum creatinine based on age/sex as follows:

       -  1 to < 2 years: male = 0.6; female = 0.6

       -  2 to < 6 years: male = 0.8; female = 0.8

       -  6 to < 10 years: male = 1; female = 1

       -  10 to < 13 years: male = 1.2; female = 1.2

       -  13 to < 16 years: male = 1.5; female = 1.4

       -  >= 16 years: male = 1.7; female = 1.4

  -  Total bilirubin =< 1.5 x upper limit of normal (ULN) for age, and

  -  Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 10 x
     ULN; for the purposes of this study, ULN for SGPT (ALT) is 45

  -  Shortening fraction of >= 27% by echocardiogram, or ejection fraction of >= 50% by
     echocardiogram or radionuclide angiogram

  -  No known contraindication to peripheral blood stem cell (PBSC) collection; examples of
     contraindications might be a weight or size less than the collecting institution finds
     feasible, or a physical condition that would limit the ability of the child to undergo
     apheresis catheter placement (if necessary) and/or the apheresis procedure

Exclusion Criteria:

  -  Patients with INRG stage L2 tumors without amplification of MYCN regardless of tumor
     histology (may meet criteria for may meet criteria for high risk classification but
     are not eligible for this trial)

  -  Patients with bone marrow failure syndromes

  -  Patients for whom targeted radiopharmaceutical therapy would be contraindicated due to
     underlying medical disorders

  -  Female patients who are pregnant; a pregnancy test is required for female patients of
     childbearing potential

  -  Lactating females who plan to breastfeed their infants

  -  Sexually active patients of reproductive potential who have not agreed to use an
     effective contraceptive method for the duration of their study participation

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